CONTENTS

About This Course

Table of Contents

1. Introduction to the Issues
2. Understanding Alcohol Abuse
3. Understanding Violence Against Women
4. Alcohol and Domestic Violence
5. Alcohol, Sexual Assault, and Rape
6. Prevention and Early Intervention
7. Screening and Assessment
8. Diagnosis and Treatment
9. Legal and Ethical Issues

Supplements
Fact Sheets
Videos
Resources

Silence Hurts:
Alcohol Abuse and Violence Against Women

Prevention and Early Intervention

Overview

Prevention is a process where we anticipate a problem and address it before it becomes a reality. In healthcare, this may involve asking patients about their alcohol intake or situation at home. Prevention also involves connecting people and resources with ideas, strategies, and programs. The overall goal of prevention (of alcohol abuse or violence) is to enable the person to stop the harmful behavior or situation. To do this, a person may need to be taught coping and problem-solving skills.

Prevention Framework

Prevention is aimed at general population groups with various levels of risk for alcohol-related violence problems. The Institute of Medicine created a prevention program classification system that helps match interventions to the needs of a targeted population.¹ Three types of intervention are:

• Universal programs: These target general population groups, not just those at risk. Examples include health seminars or posters in a cafeteria or health center.
• Selective programs: These target individuals who are at higher-than-average risk for alcohol abuse or violence. Examples include server interventions at bars, screenings, and brief interventions.
• Indicated programs: These target women who are already using or engaged in other high-risk behaviors in order to prevent chronic alcohol use and severe problems. Examples include programs targeting abused or addicted women.

Many alternate activities exist to provide women culturally and age appropriate options to help replace, reduce, or eliminate involvement in substance using activities. Peer support and faith-based activities often provide an additional connection for women.

Community-based strategies try to expand community resources dedicated to reducing alcohol abuse and violence against women. An example may be building community coalitions to help support abused women. Strategies include environmental approaches to promote policy and system changes that reduce risk factors and increase supports.

Aspects of Prevention Programs

Prevention programs focus on stopping self-destructive or harmful behaviors, both to self and to others. They also promote health and wellness. Effective prevention programs generally include:

• Outreach. Make sure the location of the program is convenient for people to get to.
• Age-appropriate materials. Teenagers and youth have different needs than older adults. Make sure materials reflect the age group that is being targeted.
• Independence. Many abused women especially feel as if they have no control over their lives. It is important for these programs to encourage regaining independence, confidence, and self-worth.
• Culturally sensitive approaches. Culturally and generationally sensitive programs promote respect and allows participants to take pride in their cultural heritage.

Early Intervention

Problem identification is needed to recognize individuals with suspected alcohol abuse or family violence problems to address the issues before they worsen. Health care providers can do routine evaluations for alcohol consumption, home violence, and related risk factors to help identify these women.

A key issue in early intervention is motivating change. Motivation is not just the responsibility of the problem drinker, but also is the result of interactions between the drinker and others. A therapist can increase motivation for change through his or her interactions with the client.

People respond quite differently to recommendations that they discontinue or alter pleasurable behaviors. Reactions depend, to a great extent, on an individual's readiness to change.² Screening or assessment findings may confirm a person's suspicions about the negative effect of alcohol on personal health. Others may need time to process the information uncovered during the assessment. Still others may be unconvinced by the findings and not see the need to change.

Most people experience several stages of change in addressing an alcohol problem.³ The stages include: Pre-contemplation, contemplation, determination, action, and maintenance. Relapse is often included because many individuals experience relapse and subsequently repeat the stages of change.

For more information for consumers, go to www.samhsa.gov/preventionpathways and click on "courses" to find the online course, "It Won't Happen To Me: Substance Abuse and Violence Against Women."

References

• Kumpfer, K. L., Alexander, J. F., McDonald, L., et al. (1998). Family-focused substance abuse prevention: What has been learned from other fields. In R. S. Ashery, E. B. Robertson, and K. L. Kumpfer (Eds.), Drug abuse prevention through family interactions. NIDA Research Monograph 177. NIH Publication No. 97-4135. Rockville, MD: National Institute on Drug Abuse.
• Prochaska, J. O., DiClemente, C. C., and Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114.
• Prochaska, J., and DiClemente, C. (1986). Toward a comprehensive model of change. In W. R. Miller and N. Heather (Eds.), Treating addictive behaviors: Processes of change (pp. 3-27). New York: Plenum Press.